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Pressure grows for lawmakers to pass postpartum Medicaid extension

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Pressure grows for lawmakers to pass postpartum Medicaid extension

As the first major legislative deadline of 2023 nears, legislative leaders face growing pressure to extend health care coverage for moms on Medicaid from two months to one year.

After Speaker of the House Philip Gunn killed the effort last year, a bipartisan coalition of lawmakers, mothers across the state and health care professionals are ratcheting up the conversation at the Capitol this session about the benefits of the bill for Mississippi mothers and children. Mississippi, as it has for many years in a row, has the highest infant mortality rate and among the highest maternal mortality rates in the nation.

Several lawmakers — Republicans and Democrats in both the House and Senate — filed bills early this year to extend the Medicaid coverage to one year. This would put Mississippi on the same page as 29 other states, including most of the Southeast. Eight additional states are currently considering full extended coverage or a limited extension of coverage.

The Senate last year overwhelmingly passed the legislation and has since held hearings where experts and physicians spoke to its positive impact on women and babies’ health. Several senators filed bills early this year to extend postpartum Medicaid coverage, and Lt. Gov. Delbert Hosemann said he would usher it through his chamber.

And in the House, Rep. Missy McGee, R-Hattiesburg, filed a bill this year to extend the coverage. Several of her Republican colleagues, including Rep. Rob Roberson, R-Starkville, co-authored the bill.

“I really think that this is a pro-family position and certainly a pro-life position to take care of these moms who are carrying and delivering and bringing these babies into the world,” McGee said. “Healthy moms equal healthy babies. They go hand in hand, so I really believe it’s currently the most impactful thing we can do for women and children.”

Roberson, who authored the main postpartum bill last year that the House never had the opportunity to vote on, also cited being pro-life as a reason he fully supports the extension.

“I feel like if you’re pro-life, then this is a pro-life issue,” Robertson said. “You support the baby and the mother for as long as we can, and obviously we have financial constraints that enter into this, but I do think in the long run it would be less expensive and more conducive to the health of that child and that mother.”

But that momentum could halt, as it did last year, at the House dais, where Gunn wields immense power. He could, as he did last year, block the issue from ever coming up for a full vote.

Gunn spoke to Mississippi Today this week about his stance on the proposal. He said he believes the Mississippi Division of Medicaid should act — not the Legislature — to extend the coverage.

“My point is, any time I can call an agency and say, ‘Fix this by regulation, it doesn’t take legislation,’ that’s the best way to do it,” Gunn told Mississippi Today on Monday. “Legislation is the hardest way to get it done. If the Division of Medicaid felt like it was a good idea, they could’ve submitted a request a year ago and I believe CMS would grant it in a heartbeat.”

The Division of Medicaid has not taken a stance on extending postpartum coverage. But even a committee appointed by Republican leaders, including Gunn, to advise on Medicaid policy recommended that the Legislature extend postpartum coverage.

Dr. David Reeves, a pediatrician from the Gulf Coast whom Gunn appointed to the committee tasked by law to advise and make recommendations to the agency, penned a letter to state leaders, including Gunn, earlier this year urging them to extend postpartum Medicaid coverage to 12 months. 

“I see moms that lost postnatal care after a few months and ended up pregnant again, or have postpartum depression and couldn’t get treatment,” Reeves told Mississippi Today. “A lot of women do have complications during pregnancy, and they need follow up (care) that will take more than two months — like for gestational diabetes, hypertension … These things need continued coverage.”

Gunn said he had not seen Dr. Reeves’ letter. The Division of Medicaid, which is housed under the governor’s office, did not respond to questions Mississippi Today sent over a five-day period. Medicaid Executive Director Drew Snyder did not return text messages to his personal cell phone about the issue.

Staffers for Gov. Tate Reeves, who oversees the Division of Medicaid and appointed Snyder, also ignored questions from Mississippi Today on the topic of extending postpartum coverage.

In the Mississippi Today interview this week, Gunn said he has asked the Division of Medicaid for data on how continuous coverage during the federal public health emergency impacted health outcomes for women and babies, but he has not received it. Trey Dellinger, Gunn’s chief of staff, told Mississippi Today he wanted to see data that covers whether there was “any actual change in maternal or infant mortality.”

Experts say Gunn’s office hasn’t seen that data because it does not exist yet.

“The research awards for … what the full impact of the postpartum coverage extension has been — those were just awarded, and they’re five year grants,” said Maggie Clark, senior state health policy analyst for Georgetown University Center for Children and Families. “We’re not going to know the impact of this (extended coverage during the Public Health Emergency) nationally and definitely at the state level for many years.”

In Mississippi, for example, the latest maternal mortality data available is for the time period of 2013-2016. The Health Department has said it plans to release a report for 2017 through 2019 soon.

Clark made another point about making decisions around postpartum based solely on mortality numbers.

“The goal of extending postpartum coverage is to support maternal health. There’s a lot more to maternal health than, ‘Did you die?’” she said. “That’s just the absolute bare minimum.”

A recent Texas study, however, showed postpartum women with continuous coverage used twice as many postpartum services, up to 10 times as many preventive, contraceptive and mental health services, and 37% fewer services related to what’s called “short interval pregnancies” within the first year postpartum compared to before continuous coverage was in place.

Short interval pregnancies are defined as becoming pregnant within six months after giving birth – and they are associated with a higher risk for preterm birth. For mothers over 35 with short interval pregnancies, there’s an increased risk of death and serious illness. 

Dellinger, Gunn’s chief of staff, said they had reviewed that study but concluded it was not the data they needed to see.

“The Texas study you sent us, it showed there was increased utilization of health care services,” Dellinger said. “But what it didn’t cover was whether there was any improvement in outcomes.”

But according to Clark, the Texas study is “one of the only, if not the only” such study. She also pointed out the time frame researchers looked at was early in the pandemic (March to December 2020) — when health care utilization as a whole was down.

A reduction in short interval pregnancies, Clark said, is a positive health outcome.

The Texas study also showed an increase in the use of mental health and substance use services. Data shows mental health conditions (including substance use disorder) are the leading underlying cause in maternal mortality.

“The Texas study showing increases in services for mental health and substance use disorder is significant, because these conditions are drivers of maternal mortality,” said Clark.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

On this day in 1961

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mississippitoday.org – Jerry Mitchell – 2024-11-22 07:00:00

Nov. 22, 1961

Credit: Courtesy: Georgia Tourism & Travel

Five Black students, made up of NAACP Youth Council members and two SNCC volunteers from Albany State College, were arrested after entering the white waiting room of the Trailways station in Albany, Georgia. 

The council members bonded out of jail, but the SNCC volunteers, Bertha Gober and Blanton Hall declined bail and “chose to remain in jail over the holidays to dramatize their demand for justice,” according to SNCC Digital Gateway. The president of Albany State College expelled them. 

Gober became one of SNCC’s Freedom Singers and wrote the song, “We’ll Never Turn Back,” after the 1961 killing of Herbert Lee in Mississippi. The tune became SNCC’s anthem. 

After her release from jail, Gober joined other students, and police arrested her and other demonstrators. Back in the same jail, she sang to the police chief and mayor to open the cells, “I hear God’s children praying in jail, ‘Freedom, freedom, freedom.’” 

Albany State suspended another student, Bernice Reagon, after she joined SNCC. She poured herself into the civil rights movement and later formed the Grammy-nominated a cappella group Sweet Honey in the Rock to educate and empower the audience and community. 

“When I opened my mouth and began to sing, there was a force and power within myself I had never heard before,” a power she said she did not know she had. 

Other members of the Freedom Singers included Cordell Reagon, Bernice Johnson, Dorothy Vallis, Rutha Harris, Bernard Lafayette and Charles Neblett. On the third anniversary of the sit-in movement in 1963, they performed at Carnegie Hall. 

“This is a singing movement,” SNCC leader James Forman told a reporter. “The songs help. Without them, it would be ugly.” 

Today, the Albany Civil Rights Institute houses exhibits on these protesters, Martin Luther King Jr. and others who joined the Albany Movement.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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IHL deletes the word ‘diversity’ from its policies

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mississippitoday.org – Molly Minta – 2024-11-21 14:32:00

The governing board of Mississippi’s public universities voted Thursday to delete the word “diversity” from several policies, including a requirement that the board evaluate university presidents on campus diversity outcomes.

Though the Legislature has not passed a bill targeting diversity, equity and inclusion initiatives in higher education, the Institutions of Higher Learning Board of Trustees approved the changes “in order to ensure continued compliance with state and federal law,” according to the board book

The move comes on the heels of the re-election of former President Donald Trump and after several universities in Mississippi have renamed their diversity offices. Earlier this year, the IHL board approved changes to the University of Southern Mississippi’s mission and vision statements that removed the words “diverse” and “inclusiveness.”

In an email, John Sewell, IHL’s communications director, did not respond to several questions about the policy changes but wrote that the board’s goal was to “reinforce our commitment to ensuring students have access to the best education possible, supported by world-class faculty and staff.”

“The end goal is to support all students, and to make sure they graduate fully prepared to enter the workforce, hopefully in Mississippi,” Sewell added.

On Thursday, trustees approved the changes without discussion after a first reading by Harold Pizzetta, the associate commissioner for legal affairs and risk management. But Sewell wrote in an email that the board discussed the policy amendments in open session two months ago during its retreat in Meridian, more than an hour away from the board’s normal meeting location in Jackson.

IHL often uses these retreats, which unlike its regular board meetings aren’t livestreamed and are rarely attended by members of the public outside of the occasional reporter, to discuss potentially controversial policy changes.

Last year, the board had a spirited discussion about a policy change that would have increased its oversight of off-campus programs during its retreat at the White House Hotel in Biloxi. In 2022, during a retreat that also took place in Meridian, trustees discussed changing the board’s tenure policies. At both retreats, a Mississippi Today reporter was the only member of the public to witness the discussions.

The changes to IHL’s diversity policy echo a shift, particularly at colleges and universities in conservative states, from concepts like diversity in favor of “access” and “opportunity.” In higher education, the term “diversity, equity and inclusion” has traditionally referred to a range of efforts to comply with civil rights laws and foster a sense of on-campus belonging among minority populations.

But in recent years, conservative politicians have contended that DEI programs are wasteful spending and racist. A bill to ban state funding for DEI in Mississippi died earlier this year, but at least 10 other states have passed laws seeking to end or restrict such initiatives at state agencies, including publicly funded universities, according to ABC News.

In Mississippi, the word “diversity” first appeared in IHL’s policies in 1998. The diversity statement was adopted in 2005 and amended in 2013. 

The board’s vote on Thursday turned the diversity statement, which was deleted in its entirety, into a “statement on higher education access and success” according to the board book. 

“One of the strengths of Mississippi is the diversity of its people,” the diversity statement read. “This diversity enriches higher education and contributes to the capacity that our students develop for living in a multicultural and interdependent world.”

Significantly, the diversity statement required the IHL board to evaluate the university presidents and the higher learning commissioner on diversity outcomes. 

The statement also included system-wide goals — some of which it is unclear if the board has achieved — to increase the enrollment and graduation rates of minority students, employ more underrepresented faculty, staff and administrators, and increase the use of minority-owned contractors and vendors. 

Sewell did not respond to questions about if IHL has met those goals or if the board will continue to evaluate presidents on diversity outcomes.

In the new policy, those requirements were replaced with two paragraphs about the importance of respectful dialogue on campus and access to higher education for all Mississippians. 

“We encourage all members of the academic community to engage in respectful, meaningful discourse with the aim of promoting critical thinking in the pursuit of knowledge, a deeper understanding of the human condition, and the development of character,” the new policy reads. “All students should be supported in their educational journey through programming and services designed to have a positive effect on their individual academic performance, retention, and graduation.” 

Also excised was a policy that listed common characteristics of universities in Mississippi, including “a commitment to ethnic and gender diversity,” among others. Another policy on institutional scholarships was also edited to remove a clause that required such programs to “promote diversity.” 

“IHL is committed to higher education access and success among all populations to assist the state of Mississippi in meeting its enrollment and degree completion goals, as well as building a highly-skilled workforce,” the institutional scholarship policy now reads. 

The board also approved a change that requires the universities to review their institutional mission statements on an annual basis.

A policy on “planning principles” will continue to include the word “diverse,” and a policy that states the presidential search advisory committees will “be representative in terms of diversity” was left unchanged.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Closed St. Dominic’s mental health beds to reopen in December under new management

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mississippitoday.org – Gwen Dilworth – 2024-11-21 13:54:00

The shuttered St. Dominic’s mental health unit will reopen under the management of a for-profit, Texas-based company next month. 

Oceans Behavioral Hospital Jackson, a 77-bed facility, will provide inpatient behavioral health services to adults and seniors and add intensive outpatient treatment services next year. 

“Jackson continuously ranks as one of the cities for our company that shows one of the greatest needs in terms of behavioral health,” Oceans Healthcare CEO Stuart Archer told Mississippi Today at a ribbon cutting ceremony at its location on St. Dominic’s campus Thursday. “…There’s been an outcry for high quality care.” 

St. Dominic’s 83-bed mental health unit closed suddenly in June 2023, citing “substantial financial challenges.”

Merit Health Central, which operates a 71-bed psychiatric health hospital unit in Jackson, sued Oceans in March, arguing that the new hospital violated the law by using a workaround to avoid a State Health Department requirement that the hospital spend at least 17% of its gross patient revenue on indigent and charity care.

Without a required threshold for this care, Merit Health Central will shoulder the burden of treating more non-paying patients, the hospital in South Jackson argued. 

The suit, which also names St. Dominic’s Hospital and the Mississippi Department of Health as defendants, awaits a ruling from Hinds County Chancery Court Judge Tametrice Hodges-Linzey next year. 

The complaint does not bar Oceans from moving forward with its plans to reopen, said Archer.

A hallway inside Oceans Behavioral Hospital in Jackson, Miss., is seen on Thursday, Nov. 21, 2024, during the facility’s grand opening. Credit: Eric Shelton/Mississippi Today

Oceans operates two other mental health facilities in Mississippi and over 30 other locations in Louisiana, Oklahoma and Texas. 

“Oceans is very important to the Coast, to Tupelo, and it’s important right here in this building. It’s part of the state of Mississippi’s response to making sure people receive adequate mental health care in Mississippi,” said Lt. Governor Delbert Hosemann at the Nov. 21 ribbon cutting.

Some community leaders have been critical of the facility. 

“Oceans plans to duplicate existing services available to insured patients while ignoring the underserved and indigent population in need,” wrote Hinds County Sheriff Tyree Jones in an Oct. 1 letter provided to Mississippi Today by Merit Health. 

Massachusetts-based Webster Equity Partners, a private-equity firm with a number of investments in health care, bought Oceans in 2022. St. Dominic’s is owned by Louisiana-based Catholic nonprofit Franciscan Missionaries of Our Lady Health System.

Oceans first filed a “certificate of need” application to reopen the St. Dominic’s mental health unit in October 2023. 

Mississippi’s certificate of need law requires medical facilities to receive approval from the state before opening a new health care center to demonstrate there is a need for its services. 

The Department of Health approved the application under the condition that the hospital spend at least 17% of its patient revenue on free or low-cost medical care for low-income individuals – far more than the two percent it proposed. 

Stuart Archer, CEO of Oceans Healthcare, speaks during the grand opening of Oceans Behavioral Hospital in Jackson, Miss., on Thursday, Nov. 21, 2024. Credit: Eric Shelton/Mississippi Today

Oceans projected in its application that the hospital’s profit would equal $2.6 million in its third year, and it would spend $341,103 on charity care.

Merit Health contested the conditional approval, arguing that because its mental health unit provides 22% charity care, Oceans providing less would have a “significant adverse effect” on Merit by diverting more patients without insurance or unable to pay for care to its beds. 

Oceans and St. Dominic’s also opposed the state’s charity care condition, arguing that 17% was an unreasonable figure. 

But before a public hearing could be held on the matter, Oceans and St. Dominic’s filed for a “change of ownership,” bypassing the certificate of need process entirely. The state approved the application 11 days later

Merit Health Central then sued Oceans, St. Dominic and the State Department of Health, seeking to nullify the change of ownership. 

“The (change of ownership) filing and DOH approval … are nothing more than an ‘end run’ around CON law,” wrote Merit Health in the complaint. 

Oceans, St. Dominic’s and the Mississippi Department of Health have filed motions to dismiss the case. 

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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